A few hallmarks of healthy eating are at the core of an endometriosis diet. Find out which foods can help.

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Dian Shepperson Mills, MA, is a British nutritionist who pioneered a dietary program for endometriosis and has spoken around the world on the subject of endometriosis and diet. She is director of the Endometriosis and Fertility Clinic in London and Sussex, England; chair of the Nutrition Special Interest Group at the American Society for Reproductive Medicine; and author of Endometriosis: A Key to Healing and Fertility through Nutrition.

The theory behind her endometriosis diet: “The diet aims to reduce internal inflammation within the body, improve pain responses, and support estrogen excretion from the body," Shepperson Mills explains. She says that 20,000 women have tried the diet and many reported improvement in pain levels and fertility.

How Diet May Affect Endometriosis

“Women with endometriosis should avoid fatty foods, such as red meat and [high-fat] dairy foods that may be high in PCBs and dioxins, to reduce their exposure to these estrogenic pesticides,” she suggests. Use organic food whenever feasible, or peel fruits and vegetables, she recommends. Some research suggests a link between dioxins in the environment and increased levels of estrogen.

Shepperson Mills also cites studies that found an association between oxidative stress — which includes the formation of cell-damaging substances called free radicals — and endometriosis. Additional research found that a lack of antioxidants may contribute to endometriosis, while absorbing key antioxidant nutrients like selenium and vitamins A, C, and E may help keep it under control.

What to Eat for Endometriosis

The core of Shepperson Mills’ diet for endometriosis includes these hallmarks of healthy nutrition:

Freshness. Buy the freshest food you can find and eat it while it’s fresh. Avoid highly processed foods full of additives. Cook with fresh foods, but also eat some raw vegetables and fruit every day. To minimize exposure to pesticides, eat organically grown produce whenever possible.

Variety. Eat a wide variety of foods every day. “Make it fun to try new dishes on weekends and expand your horizons,” says Shepperson Mills.

Your daily diet should provide 75 grams of good quality protein from sources like meat and game, fish, eggs, and low-fat dairy products. Also include nuts, seeds, and legumes (such as beans), two portions of red or orange vegetables, two green leafy vegetables, and two fruits, including berries, which are high in antioxidants.

Vegetables with B vitamins. “A healthy liver with a plentiful supply of B vitamins can degrade estradiol to estriol,” Shepperson Mills says. “Estriol is the form in which estrogen can be bound to fiber and excreted. The diet needs to have sufficient fiber and B vitamins from green vegetables to help the body deal with the constant breakdown of circulating estrogens. Green, leafy vegetables can also help the nervous and immune systems, and magnesium relaxes smooth muscles found in the intestines and uterus.”. The best vegetables: those in the cruciferous family, such as cabbage, sprouts, broccoli, cauliflower, kale, turnips, radishes, horseradish, and watercress.

Iron-rich foods. “With endometriosis you may experience heavy bleeding, so replacing lost iron is important,” she says. Two types of iron are available in the foods we eat, heme iron from protein sources and non-heme iron from plant sources. Non-heme iron is available in green, leafy vegetables, beetroot, dried apricots, and plain chocolate. Heme iron comes from red meat, eggs, and fish.

Water. Drink four to six 8-ounce glasses of water a day. Avoid caffeine, refined sugars, sweeteners, soda (including diet), and alcohol when struggling with endometriosis or trying to get pregnant.

The Role of Supplements in an Endometriosis Diet

“Obtaining nutrients from food sources is obviously best,” says Shepperson Mills. “The judicious use of nutritional supplements may also improve reproductive health. Use only good quality supplements, free from yeast, gluten, wheat, dairy, and sugars, and stick to the dose on the carton or bottle.”

What About Gluten?

Shepperson Mills is investigating the role gluten might play in endometriosis. “Eating a wheat-free diet seems to help many women with endometriosis symptoms. Whether this is a result of gluten or another component of wheat is unclear,” she believes. “It may be worth excluding wheat for one month to see if it makes a difference to your abdominal pains at periods and ovulation. You could also try to exclude dairy foods if you have excess mucus problems.”

Another food you may want to skip is citrus fruit, like grapefruit and oranges — they can irritate your stomach and upset the way in which estrogen is excreted by the body. When excluding foods from your diet, make sure to eat alternatives so you avoid any nutrient deficiencies.

“If a food is upsetting digestion and causing an immune system response, then that food should be avoided,” says Shepperson Mills.

Some doctors aren’t sure that the diet is beneficial in terms of endometriosis relief per se. “Endometriosis is a funny entity in the sense of immunology," says John C. Petrozza, MD, board-certified ob-gyn and chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility Center in Boston. Patients with endometriosis tend to have " problems with asthma, allergies — it’s not uncommon to have irritable bowel syndrome, also lactose intolerance, gluten intolerance," he says. "So is the diet really helping the endometriosis or the symptoms of irritable bowel syndrome?”

The bottom line: If you have endometriosis, talk to your doctor or registered dietitian to see if this diet might be worth trying.

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